Know These Codes for Reporting Tumor Board Meeting
Question: Can I use 99358/+99359 to account for time when presenting a case for a specific patient for a tumor board meeting? AAPC Forum Participant Answer: CPT® code 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) and its add-on code +99359 (each additional 30 minutes (List separately in addition to code for prolonged service)) are appropriate when documenting time spent preparing for, or evaluating the outcome of, a treatment plan for a specific patient. However, CPT® guidelines state you should not report 99358/+99359 “for time without direct patient contact reported in other services,” such as 99366 (Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional) or 99367 (Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician) — the codes you would report if your provider is the only meeting participant reporting the service. Presumably, this is because CPT® regards the work involved in preparing a case for a tumor board meeting as being folded into 99366/99367, and you should only bill 99358/+99359 if your provider is not reporting 99366/99367. Additionally, 99358/+99359 are not valid for Medicare payment, as the Centers for Medicare & Medicaid Services (CMS) has assigned the codes a status indicator of “I” (“Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services.”). For Medicare, you would use G2212 (Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure…; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact…), according to CMS. Remember: According to the code descriptor for the Medicare prolonged service code, you can only use G2212 in conjunction with evaluation and management (E/M) service codes 99205 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a… high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded) or 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a… high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded). Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
